Bethany McLeman

Background: Addressing the opioid crisis requires an interdisciplinary approach. Pharmacists may provide medication expertise to primary care addiction teams. Objective: To determine whether implementing a pharmacist-integrated model of care for opioid use disorder (PrIMO) was feasible and acceptable. Design: Nonrandomized mixed-methods longitudinal feasibility/implementation trial conducted from March 2022 to October 2024. Participants: Four primary care sites with retail pharmacies and clinical pharmacists. Participants were adults employed by the clinics and adult patients receiving medications for opioid use disorder (MOUD) exposed to PrIMO for at least 2 weeks. Site staff (provider, pharmacists, leadership) were surveyed for 15 months (80.6% follow-up completion) and patients for 6 months (75.5% follow-up completion). Intervention: Pharmacist-integrated MOUD. Main Measures: Primary: Feasibility (PrIMO launch). Secondary: acceptability (survey and interview data) and impact (electronic health record data). Key Results: All sites launched PrIMO (100%) and maintained it for at least 1 year. From 3 months pre- to 1 year post-launch, site staff reported fewer barriers to providing MOUD ( m [SD] 2.2 [0.8] to 1.8 [0.5], 1–4-point scale), increased knowledge of MOUD (3.8 [0.4] to 4.0 [0.5], 1–5-point scale), and steady acceptability by providers/pharmacists (2.1 [0.3] to 2.0 [0.4], 0–3-point scale) and leadership (2.1 [0.3] to 2.0 [0.4], 0–3-point scale). Patients reported less stigma (3.1 [1.1] to 2.8 [1.1], 1–5-point scale) and steady acceptability (2.2 [0.4] to 2.2 [0.4], 0–3-point scale). Electronic health records data demonstrated increases in the rate of patients retained in MOUD ( m [SD] 59.5 [34.81] to 60.2 [35.35] proportion of days covered), adherence to MOUD (38.6 to 40.9%), clinic visits for MOUD (+ 100 encounters), and total patients treated per prescriber ( m [SD] 12.9 [32.49] to 13.7 [35.07]) 1 year pre- vs 1 year post-launch, although statistical significance was not assessed. Conclusions: Integrating pharmacists into MOUD care teams may improve feasibility and acceptability of MOUD in primary care. Clinical Trial Registration: ClinicalTrials.gov, NCT05310786, March 14, 2022

Background: Opioid-related fatal overdoses are occurring at historically high levels and increasing each year. Accessible social and financial support are imperative to the initiation and success of treatment for Opioid Use Disorder (OUD). Medications for Opioid Use Disorder (MOUD) offer effective treatment but there are many more people with untreated OUD than receiving evidence-based medication. Patient-centered care is associated with increased care utilization for substance use disorders. This qualitative study explored the patient perspective of OUD care through a Patient-Centered Care (PCC) framework to illuminate patients’ sense of engagement in care. Methods: Fifteen semi-structured telephone interviews were conducted from August through November of 2021 regarding patient experiences receiving MOUD in 13 Vermont Hub and Spoke clinics. Emergent themes were deductively mapped to PCC domains of Therapeutic Alliance, Individualized Care, Shared Decision-Making, and Holistic Care. Results: Participants indicated that PCC fostered engagement and often characterized MOUD clinics they no longer attended as lacking in PCC. Themes related to Therapeutic Alliance were the most prevalent and suggest pathways to retention. Individualizing care through flexible appointment scheduling was strongly valued, while inflexible scheduling fostered fear of not getting medication. Some participants indicated they were less likely to remain in care when providers did not include them in decisions about medication type, dose, or formulation. Participants also appreciated holistic biopsychosocial care and care referrals. Conclusions: Patient-centered MOUD care was important to participants and encouraged engagement in care. Prioritizing alliance with patients, adapting care to patient needs and preferences particularly when scheduling, including patients in medication decisions, and biopsychosocial attention to patients are congruent with patient perception of desirable MOUD care. Having this understanding of an established, leading MOUD treatment system may serve to benefit states looking to implement this model, or for states who are looking to improve the model they already have in place, potentially leading to higher treatment and retention rates. Trial registration: This was not a clinical trial involving an intervention, and therefore registration was not required.

Background: In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity. Objective: This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants. Methods: We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ≥50% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study’s potential to facilitate insights into the impact of a TBI for members of specific URM groups. Results: Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1% (43/110) randomized trials, and 35.5% (39/110) feasibility studies. In total, 47.3% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9%), alcohol alone (26/110, 23.6%), opioids (8/110, 7.3%), cannabis (6/110, 5.5%), cocaine (4/110, 3.6%), and methamphetamines (3/110, 2.7%). Of the studies that consciously considered race or ethnicity (29/110, 26.4%), 6.4% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups. Conclusions: While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity.

Background: Although tobacco use has significantly declined in the general population, traditional tobacco use treatment uptake and success rates remain disproportionately low among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Technology-based interventions (TBIs) for tobacco use are promising alternatives to traditional tobacco use treatments. Objective: This scoping review aims to investigate the extent to which the use of digital TBIs in tobacco use treatment research promotes health equity among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Methods: This scoping review identifies US-based studies (between January 2000 and March 2021) that enlist TBIs for tobacco use treatment and include people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native at ≥50% of the sample when combined; features studies that are also race and ethnicity conscious; and highlights health equity–promoting insights from included studies. Results: In 85% (22/26) of the studies, the largest proportion of the sample was African American/Black, most participants had low socioeconomic status, and recruitment was most commonly from medical settings. In total, 58% (15/26) of the studies were race and ethnicity conscious, and 67% (10/15) of these studies sought to partner with potential end users. An array of TBIs were represented; however, SMS text messaging was most prevalent. Most TBIs were combined with other evidence-based intervention components (eg, nicotine replacement therapy). Approximately one-third of the studies (8/26, 31%) required participants to have their own device or internet access. The majority were underpowered to detect substantial differences. Conclusions: The modest number of studies, particularly for persons who identify as Hispanic/Latina/o and American Indian/Alaska Native, demonstrates the limited application of TBIs for tobacco use and that additional research is needed to determine the extent to which TBIs for tobacco use promote health equity among these populations. International Registered Report Identifier (IRRID): RR2-10.2196/34508

Background: Pharmacists remain an underutilized resource in the treatment of opioid use disorder (OUD). Although studies have engaged pharmacists in dispensing medications for OUD (MOUD), few studies have evaluated collaborative care models in which pharmacists are an active, integrated part of a primary care team offering OUD care. Methods: This study seeks to implement a pharmacist integrated MOUD clinical model (called PrIMO) and evaluate its feasibility, acceptability, and impact across four diverse primary care sites. The Consolidated Framework for Implementation Research is used as an organizing framework for study development and interpretation of findings. Implementation Facilitation is used to support PrIMO adoption. We assess the primary outcome, the feasibility of implementing PrIMO, using the Stages of Implementation Completion (SIC). We evaluate the acceptability and impact of the PrIMO model at the sites using mixed-methods and combine survey and interview data from providers, pharmacists, pharmacy technicians, administrators, and patients receiving MOUD at the primary care sites with patient electronic health record data. We hypothesize that it is feasible to launch delivery of the PrIMO model (reach SIC Stage 6), and that it is acceptable, will positively impact patient outcomes 1 year post model launch (e.g., increased MOUD treatment retention, medication regimen adherence, service utilization for co-morbid conditions, and decreased substance use), and will increase each site’s capacity to care for patients with MOUD (e.g., increased number of patients, number of prescribers, and rate of patients per prescriber). Discussion: This study will provide data on a pharmacist-integrated collaborative model of care for the treatment of OUD that may be feasible, acceptable to both site staff and patients and may favorably impact patients’ access to MOUD and treatment outcomes. Trial registration: The study was registered on Clinicaltrials.gov (NCT05310786) on April 5, 2022, https://www.clinicaltrials.gov/study/NCT05310786?id=NCT05310786&rank=1

BACKGROUND In the United States, racial and ethnic disparities in substance use treatment outcomes are persistent, especially among underrepresented minority (URM) populations. Technology-based interventions (TBIs) for substance use treatment show promise in reducing barriers to evidence-based treatment, yet no studies have described how TBIs may impact racial or ethnic health equity. OBJECTIVE This study explored whether TBIs in substance use treatment research promote health equity among people who identify as African American or Black, Hispanic or Latino, and American Indian or Alaska Native through their inclusion in research. We explored whether research that includes the aforementioned groups consciously considers race and/or ethnicity beyond including these populations as participants. METHODS We conducted a scoping review of 5 electronic databases to identify TBIs in substance use treatment studies published in English between January 2000 and March 2021. Studies were included if ≥50% of participants identified as African American or Black, Hispanic or Latino, or American Indian or Alaska Native when combined. Included studies were evaluated for conscious consideration of race and ethnicity in at least one manuscript section. Finally, we conducted a critical appraisal of each study’s potential to facilitate insights into the impact of a TBI for members of specific URM groups. RESULTS Of 6897 titles and abstracts screened and 1158 full-text articles assessed for eligibility, nearly half (532/1158, 45.9%) of the full-text articles were excluded due to the absence of data on race, ethnicity, or not meeting the aforementioned demographic eligibility criteria. Overall, 110 studies met the inclusion criteria. Study designs included 39.1% (43/110) randomized trials, and 35.5% (39/110) feasibility studies. In total, 47.3% (52/110) of studies used computer-based interventions, including electronic screening, brief interventions, and referrals to treatment, whereas 33.6% (37/110) used interactive voice response, ecological momentary assessment or interventions, or SMS text messaging via mobile phones. Studies focused on the following substances: alcohol or drugs (45/110, 40.9%), alcohol alone (26/110, 23.6%), opioids (8/110, 7.3%), cannabis (6/110, 5.5%), cocaine (4/110, 3.6%), and methamphetamines (3/110, 2.7%). Of the studies that consciously considered race or ethnicity (29/110, 26.4%), 6.4% (7/110) explicitly considered race or ethnicity in all manuscript sections. Overall, 28.2% (31/110) of the studies were critically appraised as having a high confidence in the interpretability of the findings for specific URM groups. CONCLUSIONS While the prevalence of TBIs in substance use treatment has increased recently, studies that include and consciously consider URM groups are rare, especially for American Indian or Alaska Native and Hispanic or Latino groups. This review highlights the limited research on TBIs in substance use treatment that promotes racial and ethnic health equity and provides context, insights, and direction for researchers working to develop and evaluate digital technology substance use interventions while promoting health equity.

BACKGROUND Although tobacco use has significantly declined in the general population, traditional tobacco use treatment uptake and success rates remain disproportionately low among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. Technology-based interventions (TBIs) for tobacco use are promising alternatives to traditional tobacco use treatments. OBJECTIVE This scoping review aims to investigate the extent to which the use of digital TBIs in tobacco use treatment research promotes health equity among people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native. METHODS This scoping review identifies US-based studies (between January 2000 and March 2021) that enlist TBIs for tobacco use treatment and include people who identify as African American/Black, Hispanic/Latina/o, and American Indian/Alaska Native at ≥50% of the sample when combined; features studies that are also race and ethnicity conscious; and highlights health equity–promoting insights from included studies. RESULTS In 85% (22/26) of the studies, the largest proportion of the sample was African American/Black, most participants had low socioeconomic status, and recruitment was most commonly from medical settings. In total, 58% (15/26) of the studies were race and ethnicity conscious, and 67% (10/15) of these studies sought to partner with potential end users. An array of TBIs were represented; however, SMS text messaging was most prevalent. Most TBIs were combined with other evidence-based intervention components (eg, nicotine replacement therapy). Approximately one-third of the studies (8/26, 31%) required participants to have their own device or internet access. The majority were underpowered to detect substantial differences. CONCLUSIONS The modest number of studies, particularly for persons who identify as Hispanic/Latina/o and American Indian/Alaska Native, demonstrates the limited application of TBIs for tobacco use and that additional research is needed to determine the extent to which TBIs for tobacco use promote health equity among these populations. INTERNATIONAL REGISTERED REPORT RR2-10.2196/34508